{
"Npi": {
"NPI": "1437748803",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "EVERLY",
"FirstName": "MICHELLE",
"MiddleName": "ANN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FERGUSON",
"OtherFirstName": "MICHELLE",
"OtherMiddleName": "ANN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PA-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "407 CHAPMAN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JOHNSON CITY",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37604-1644",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-747-8039",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4409 CENTRAL AVENUE PIKE # 102103",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KNOXVILLE",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37912-4081",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-747-8039",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/11/2021",
"LastUpdateDate": "02/20/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "02/12/2026",
"NPIReactivationDate": "02/20/2026",
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "121040071206",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"LicenseNumber": "121040071206",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "5278",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}